Study finds Current Medical Practices often Not Re-Evaluated, Many offer little Net Benefit Interview with Dr. Vinay Prasad, MD
Medical Oncology Branch, National Cancer Institute
National Institutes of Health, 10 Center Dr 10/12N226, Bethesda, MD20892. What are the main findings of the study?

Dr. Prasad: We reviewed all original articles in the New England Journal of Medicine over ten years.  1344 articles tested some medical practice– which is a screening or diagnostic test, medication, procedure or surgery.  Only 27% or 363 articles tested current medical practice.  And of these articles 146 (40%) contradicted current standard of care, constituting a medical reversal. Were any of the findings unexpected?

Dr. Prasad: Yes, we were surprised that such a large fraction (40%) of established standard of care is incorrect. What should clinicians and patients take away from your report?

Dr. Prasad: Clinicians and patients should realize that if a medical practice is not supported by a large well done RCT powered for hard endpoints (like morbidity or mortality), then there is the chance it could be a medical reversal.  Medical practices that are unsupported should be systematically appraised by non-conflicted bodies. What recommendations do you have for future research as a result of this study?

Dr. Prasad: Researchers should be brave in designing and conducting clinical trials.  Much of medicine is unproven, and unquestioned.  Like the 146 examples we detailed, brave investigators have the ability to lend clarity to major medical practices


A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices

Vinay Prasad, Andrae Vandross, Caitlin Toomey, Michael Cheung, Jason Rho, Steven Quinn, Satish Jacob Chacko, Durga Borkar, Victor Gall, Senthil Selvaraj, Nancy Ho,
Adam Cifu

Mayo Clinic Proceedings – 22 July 2013 (10.1016/j.mayocp.2013.05.012)